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Review: For Women at High Risk of STIs, IUD Does Not Up Risk of PID

PID risk was assessed and compared among women with and without an IUD placed

Among women with asymptomatic undiagnosed cervical infection or who are at high risk of sexually transmitted infections (STIs), intrauterine device (IUD) placement does not increase the risk of pelvic inflammatory disease (PID) compared with no IUD placement, a study published in Contraception has found.

Tara C. Jatlaoui and coauthors from the U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, aimed to assess the risk of PID among women with asymptomatic undiagnosed cervical infection or who are at high risk of STIs vs. those who have a copper-bearing (Cu-) or levonorgestrel (LNG-) IUD placed with women who do not. Study quality was evaluated using the U.S. Preventive Services Task Force Evidence Grading System.

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Of the resulting 2,220 articles, 10 met the inclusion criteria. Two studies showed a direct association of rates of PID in women with undiagnosed gonococcal or chlamydial (GC/CT) infection or at high risk for STIs initiating IUDs vs. other contraceptive methods (fair to poor) but neither study provided a difference; eight studies showed indirect evidence (fair to poor). One study cited no difference in rates of PID between women who intiated Cu vs. LNG IUDs.

Five studies compared algorithms based on patient factors with laboratory GC/CT screening to predict cervical infection. However, none of the algorithms adequately identified women at high risk of asymptomatic cervical infection who should not have an IUD placed. Moreover, no difference in PID rates was seen in two studies that compared IUD placement on the same day as STI screening with delayed placement after screening.

In general, limited data suggests that IUD placement does not increase the risk of PID compared with no IUD placement among the studied women. The algorithms based on patient characteristics "may be overly restrictive, leading to missed opportunities for IUD initiation," Jatlaoui noted. Concerns from the past about higher risk of PID among women at risk for STIs who use IUDs may not be relevant with new devices and STI screening and treatment practices, they concluded.